Clinical Microscopy Assessment Exam

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1. The principle of “protein error of indicators” is based on: * 1 point

protein changing the pH of the specimen

protein changing the pKa of the specimen

protein accepting hydrogen from the indicator

protein giving up hydrogen to the indicator

2. Which of the following is incorrectly paired regarding CSF specimen * 1 point

handling and storage temperature?

Tube 2: Microbiological studies

Cell counts: 2°C to 8°C

Tube 1: Serology

Tube 3: −15°C to −30°C

3. Which of the following incorrectly describes polyuria? * 1 point

urine volume of greater than 2.5 L/day in adults

urine volume of greater than 2.5 to 3 mL/kg/day in children

associated with diabetes mellitus but not in diabetes insipidus

NOTA

4. Microscopic urinalysis finding of a patient showed 10-25 WBCs/ HPF, 5- * 1 point

10 RBCs/ HPF, and many bacteria. No casts were seen. This is interpreted
as:

Cystitis

Acute pyelonephritis

Chronic pyelonephritis

Acute Interstitial Nephritis

5. Reiter cell contains dark cytoplasmic granules containing immune * 1 point

complexes. Macroscopically, rice bodies show collagen and fibrin and

resemble polished rice.

Only the Prst statement is correct

Only the second statement is correct

Both statements are correct

Both statements are incorrect

6. All of the following are actions of RAAS, EXCEPT: * 1 point

Stimulates sodium reabsorption in the proximal convoluted tubule

Triggers the adrenal cortex to release aldosterone causing potassium excretion

Stimulates water reabsorption in the collecting duct

Dilates the afferent and efferent arteriole

NOTA

7. Which of these is not a mechanism to maintain blood pH through the * 1 point

kidney?

excretion of hydrogen ions

excretion of acetic acid

excretion of ammonium ions

reabsorption of bicarbonate

8. Which of the following causes alkaline urine pH? I. Metabolic and * 1 point
Respiratory Acidosis II. Metabolic and Respiratory Alkalosis III. UTI caused
by E. coli IV. UTI caused by Proteus spp.

I, III

II, IV

I, IV

II, III
9. Excess urine on the reagent test strip can turn a normal pH result into a * 1 point
falsely acidic pH when which of the following reagents run into the pH pad?

Tetrabromphenol blue

Citrate buffer

Glucose oxidase

Alkaline copper sulfate

10.  Using a 1:20 dilution, an average of 80 sperm cells are counted in the * 1 point
five RBC counting squares on both sides of the hemocytometer. Calculate
the total sperm count in a specimen with a volume of 4 mL.

8,000,000 sperm/mL

32,000,000 sperm/ejaculate

80,000,000 sperm/mL

320,000,000 sperm/ejaculate

11. Which of the following is incorrect regarding ketones? * 1 point

Reagent strip tests use the sodium nitroferricyanide reaction to measure ketones.

In an acidic medium, acetoacetic acid reacts with sodium nitroprusside producing

a purple color

Both acetone and B-hydroxybutyric acid are produced from acetoacetic acid.

The proportions of 78% B-hydroxybutyric acid, 20% acetoacetic acid, and 2%

acetone are relatively constant in all specimens.
12.  Examination of synovial fluid under direct polarized light reveals short * 1 point

rods within vacuoles of the neutrophils. When a red compensator is added

and the crystals are aligned with the slow vibration, they appear blue
against a red background. These crystals are:

Monosodium urate showing positive birefringence

Monosodium urate showing negative birefringence

Calcium pyrophosphate showing positive birefringence

Calcium pyrophosphate showing negative birefringence

13. Which of the following does not cause a false positive guaiac-based * 1 point
fecal occult blood test result? I. Intake of aspirin 3 days before specimen
collection II. Addition of the developer reagent immediately after sample is
applied to the filter paper slide III. Menstrual and hemorrhoid contamination
IV. Iron supplements containing vitamin C

I, III

II, IV

II, III, IV

IV only
14. Which of the following results is a characteristic of an exudative fluid? * 1 point

SAAG: 1.2

Fluid:serum LD ratio: 0.5

WBC count: 500/μL

Fluid:serum protein ratio: 0.6

15. What is the major inorganic component of urine? * 1 point

Urea

Creatinine

Chloride

Sodium

16. A urine test on a patient shows a positive copper reduction test with a * 1 point
negative oxidase test. What is/are the possible cause/s?

Low concentration of glucose

Presence of non-glucose reducing substance

Contamination due to oxidizing agents

AOTA
17. The acrosomal cap encompasses: * 1 point

half of the head and sperm nucleus

two thirds of the head and sperm nucleus

two thirds of the head and half of the sperm nucleus

half of the head and two thirds of the sperm nucleus

18. Telescopic urine refers to the presence of? * 1 point

Many casts in the urine as seen in nephritic syndrome

Many refractive structures in the urine, thus requiring additional microscopic

techniques

Many contaminants in the urine evident even during specimen submission

Many structures in the urine that lead to speciPc diagnosis

19. Which of the following substances are reabsorbed in the proximal * 1 point
convoluted tubule via active transport?

sodium, chloride, glucose

glucose, amino acids, sodium

water, glucose, sodium

urea, water, glucose

20. p-aminohippuric acid (PAH) clearance test is a test for which of the * 1 point
following?

glomerular Pltration rate

tubular reabsorption

renal blood bow

renal plasma bow

21. Which of the following are reported as rare, few, moderate, or many per * 1 point
hpf? I. Trichomonas II. Transitional Epithelial Cells III. Mucus Threads IV.
Squamous Epithelial Cells

I, II

III, IV

I, II, III

II, III

22. Conditions that would produce an acidic urine: I. Cranberry ingestion II. * 1 point
Sleep III. Renal Tubular Acidosis IV. Gastric Lavage V. Diarrhea

III, IV

I, II, V

I, II, IV

II, V

I, II
23. The urine specific gravity of patients with end-stage renal disease: * 1 point

1.010

1.001-1.009

1.025-1.035

1.011-1.025

24. SSA precipitation test result: Turbidity with granulation and no * 1 point
flocculation. What is the correct SSA grading and the protein range?

2+; 30-100 mg/dL

2+; 100-200 mg/dL

3+; 100-200 mg/dL

3+; 200-400 mg/dL

25. Which of the following methods for specific gravity measurement is * 1 point
based on the changes in colligative properties by particle number?

Refractometry

Oscillation Densitometry

Osmolality

Reagent Strip
26. Creatinine is preferred over urea for the routine assessment of GFR * 1 point

because urea is:

reabsorbed by the tubules

unaltered by a normal diet

not affected by the urine bow rate

AOTA

27. Which of the following odor is incorrectly matched to its possible * 1 point
cause?

Hops: Methionine malabsorption

Rotting/old Psh: Tyrosinemia

Mousy: Phenylketonuria

Fruity: Strenous exercise

28. The order of cast degeneration is: * 1 point

hyaline cast > Pne granular cast > coarse granular cast > waxy cast

coarse granular cast > Pne granular cast> waxy cast

cellular cast > coarse granular cast > Pne granular cast > waxy cast

hyaline cast > coarse granular cast > Pne granular cast > cellular cast
29. An arthrocentesis performed on an elderly man experiencing elbow pain * 1 point
produces a cloudy milky fluid with low viscosity, decreased glucose level,
100,000 WBCs/uL of which <70% are neutrophils, and presence of crystals.
The fluid would be classified as:

II

III

IV

30. A cell that is most representative of severe tubular injury: * 1 point

Cell with abundant, irregular cytoplasm and a prominent nucleus about the size of
a RBC

Spherical cell with a central nucleus

Cuboidal cell with eccentric nucleus

Caudate cell with a centrally placed nucleus

31. Intravascular hemolysis due to transfusion reaction will make the blood * 1 point
test pad:

Positive after addition of ammonium sulfate

Negative after addition of ammonium sulfate

Positive with a speckled pattern on the pad

Negative yellow appears on the pad

32. All of the following are characteristics of a spinal fluid obtained from a * 1 point
traumatic tap EXCEPT: I. Even distribution of blood II. Xantochromic
supernatant III. Clotting is observed IV. No hemosiderin present

I, II

III, IV

II, IV

I, III

33. Which class of fire does grease, oils, and fats belong? * 1 point

Class B

Class C

Class D

Class K

34. Low urine D-xylose indicates: * 1 point

steatorrhea indicating a maldigestion condition

steatorrhea indicating a malabsorption condition

pancreatitis

maldigestion and malabsorption condition

35. An unpreserved urine specimen collected in the morning and remaining * 1 point
at room temperature until the afternoon shift arrives can be expected to
have: I. Increased pH and turbidity II. Decreased glucose and ketones III.
Increased bacteria and Trichomonas IV. Increased cellular elements

I, II

I, II, III

II, II, IV

I, II, III, IV

36. Which of the following best represents a hemothorax? * 1 point

Blood HCT: 42 Fluid HCT: 15

Blood HCT: 42 Fluid HCT: 10

Blood HCT: 30 Fluid HCT: 10

Blood HCT: 30 Fluid HCT: 20

37. Reagents used in split fat stain: * 1 point

95% ethyl alcohol and Sudan III

36% acetic acid and Sudan III

95% acetic acid and Oil Red O

36% ethyl alcohol and Oil Red O

38. It is defined as the presence of cast in the urine: * 1 point

Cylindruria

Cylinduria

Casturia

Telescopic urine

39. A postvasectomy analysis result that would suggest a succesful 1 point

vasectomy procedure:

Specimens are routinely tested at monthly intervals, beginning at 2 months

postvasectomy and continuing until three consecutive monthly specimens show
no spermatozoa.

Specimens are routinely tested at monthly intervals, beginning at 1 month

postvasectomy and continuing until two consecutive monthly specimens show no
spermatozoa.

Specimens are routinely tested at monthly intervals, beginning at 2 months

postvasectomy and continuing until two consecutive monthly specimens show no
spermatozoa.

Specimens are routinely tested at monthly intervals, beginning at 1 month

postvasectomy and continuing until three consecutive monthly specimens show
no spermatozoa.
40. What is the stain used to identify urinary eosinophils? * 1 point

Crystal Violet and Safranin O

0.5% Toluidine Blue

Methylene blue and Eosin Y

Prussian Blue

41. All of the following are normal findings in vaginal secretions, EXCEPT: * 1 point

pH 4.5

WBCs: 2+

Predominance of Lactobacilli

NOTA

42. Cystinuria is the defective reabsorption of : I. Cystine II. Arginine III. * 1 point
Ornithine IV. Isoleucine

I only

I, II

I, II, III

I, II, III, IV
43. Which of the following test results would indicate fetal lung immaturity? * 1 point

I. A L/S ratio of 2.0 II. Foam Stability Index: 47 III. Lamellar Body Count:
20,000/mL IV. Phosphatidylglycerol present

I, II, III

I, IV

II, III

III only

44. It is a colorless fern-like crystal soluble in acetic acid. Fern-like form can * 1 point

be induced by addition of ammonia.

Tyrosine

Sulfonamides

Struvite

Uric acid

45. Hoesch test is used for rapid screening or monitoring of: * 1 point

urobilinogen only

porphobilinogen only

urobilinogen and porphobilinogen

Ehrlich-reactive compounds
46. Watson-Schwartz differentiation test results are as follows: TUBE 1: * 1 point

Upper Layer- Urine (colorless); Bottom Layer- Chloroform (red); TUBE 2:

Upper Layer- Butanol (red); Bottom Layer- Urine (colorless). Based from
these results, which compound is present?

Urobilinogen

Porphobilinogen

Urobilinogen/ Porphobilinogen

Ehrlich-reactive compounds

47. Adenosine deaminase level highly indicative of tuberculosis: * 1 point

>20 U/L

>30 U/L

>40 U/L

<40 U/L

48. Calculate the creatinine clearance from the data given: Urine creatinine: * 1 point

130 mg/dL, Plasma creatinine: 1.5 mg/dL, 24-hour volume: 1.5 L

65 mL/min

90 mL/min

109 mL/min

114 mL/min
49. Which of the following is a metabolite of serotonin and is increased in * 1 point
some patients with carcinoid tumors?

Homovanillic acid

Vanillylmandelic acid

Benzoylecgonine

5-Hydroxyindoleacetic acid

50. In APT test, maternal hemoglobin will produce a: * 1 point

Pink solution

Yellow-brown supernatant after standing for 2 minutes

Yellow-brown precipitate after standing for 2 minutes

Red-brown supernatant after standing for 2 minutes

51. Calibration of centrifuges is performed every 6 months. Centrifuges are * 1 point

routinely disinfected on a weekly basis.

Only the Prst statement is correct

Only the second statement is correct

Both statements are correct

Both statements are incorrect

52. Which of the following casts most frequently appears to have a brittle * 1 point
consistency?

Hyaline

Granular

Waxy

Fatty

53. While measuring the absorbance of the amniotic fluid at 365 to 550 nm, * 1 point

the absorbance was highest at 410 nm, what is the indication of this result?

Bilirubin is present

Meconium

The fetus is suffering from anemia

Oxyhemoglobin is present

54. Which of the follwoing crystals are soluble in alkali? I. Uric acid II. * 1 point

Amorphous urates III. Leucine IV. Tyrosine

I, II

II only

III, IV

I, II, III, IV
55. Which of the following is incorrect regarding CSF? * 1 point

CSF is produced in the choroid plexuses of the two lumbar ventricles and the third
and fourth ventricles.

The buid bows through the subarachnoid space located between the arachnoid
and dura mater

CSF is not an ultraPltrate of plasma.

NOTA

56. What is the positive result for CTAB? * 1 point

Blue spot

Flocculation

White Turbidity

White Precipitate

57. It is the disruption of the podocytes occurring primarily in children * 1 point

following allergic reactions and immunizations.

Henoch-Schonlein Purpura

Lipid Nephrosis

Berger Disease

Alport Syndrome
58. The urine temperature for drug testing should read within the range of: * 1 point

32.7°C to 37.5°C

32.5°C to 37.5°C

32.5°C to 37.7°C

32.7°C to 37.7°C

59. When digit 3 is seen in the blue diamond on the NFPA hazardous * 1 point
material symbol, it indicates:

Normal Material

Slightly Hazardous

Hazardous

Extreme Danger

60. In adults, how much CSF is formed per hour? * 1 point

10 mL

20 mL

30 mL

40 mL
61. Which microscopic technique aids in the identification of casts and * 1 point

crystals?

Phase-contrast Microscopy

Polarizing Microscopy

Dark-Peld Microscopy

Fluorescence microscopy

62. A physician attempts to aspirate a knee joint and obtains 0.1 mL of * 1 point

slightly bloody fluid. Addition of acetic acid results in turbidity and clot. This
indicates that:

The buid is synovial buid

Plasma was obtained

Red blood cells caused a false positive reaction

The specimen is not adequate

63. What is the principle of Micral Test? * 1 point

Immunochromographics

Sensitive albumin tests related to creatinine concentration to correct for patient

hydration

Enzyme Immunoassay

Radioimmunoassay
64. After injection of ADH, a urine to serum ratio of 3:1 is achieved. This * 1 point
would be indicative of?

Neurogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

SIADH

Diabetes Mellitus

65. The use of formalin as a urine preservative would result to: * 1 point

Precipitation of amorphous phosphates and urates

Interference in drug and hormone analyses

False-negative reagent strip tests for blood and urobilinogen

Interferes with protein precipitation tests

66. Which of the following can be used to differentiate amniotic fluid from * 1 point

maternal urine? I. Urea II. Creatinine III. Glucose and Protein IV. Fern Test

I, II

I, II, IV

I, II, III

I, II, III, IV
67. Which of the following is an indirect measure of urine specific gravity? * 1 point

Urinometry

Harmonic oscillation densitometry

Refractometry

AOTA

68. Using a refractometer, the urine specific gravity at 20°C is 1.030 with 2 * 1 point

g/dL of glucose and 1 g/dL of protein. Calculate the corrected reading.

1.018

1.019

1.020

1.030

69. Dark-red brown amniotic fluid indicates what? * 1 point

Traumatic tap

Meconium

HDFN

Fetal death
70. What is the normal CSF protein? * 1 point

15-45 g/dL

15-45 mg/dL

60% to 70% that of the plasma

8 to 18 mg/dL

71. Sperm Motility: Slow forward progression, noticeable lateral movement * 1 point

4.0

3.0

2.0

1.0

72. Which of the following causes a false-positive reaction on glucose * 1 point

reagent strip?

High levels of ascorbic acid

High speciPc gravity

Contamination by detergents

AOTA
73. A urine specimen was collected on a healthy 25-year old man shortly * 1 point

after strenous exercise. What cast/s may be expected during microscopic

analysis? I. Hyaline Cast II. Fine Granular Cast III. RBC Cast IV. WBC Cast

I, II, III, IV

I, II, III

I, II

I only

74. The largest source of error in creatinine clearance tests is: * 1 point

Secretion of creatinine

Improperly timed urine specimens

Refrigeration of the urine

Time of collecting blood sample

75. A patient's urinalysis revealed a positive bilirubin and a decreased * 1 point

urobilinogen level. These results are associated with:

Hemolytic Disease

Biliary Obstruction

Hepatitis

Pernicious anemia
76. A high level of vasopressin is associated with a: * 1 point

low-volume dilute urine

large volume of dilute urine

low-volume concentrated urine

large volume of concentrated urine

77. Which of the following urine specimens is recommended for diabetes * 1 point

screening?

First morning

Second morning

Midstream clean catch

Random urine

78. A synovial fluid collected on a lavender top tube has a WBC count of 50 * 1 point

uL. The patient's uric acid is normal. Examination under polarized light
reveals extracellular birefringent crystals of varying shapes. What is the
possible cause?

The patient has septic arthritis

The specimen was collected in powdered EDTA

The patient has gout

Nothing is wrong with the result

79. If only one tube can be collected,  the CSF specimen must be tested * 1 point

first by?

Clinical Chemistry

Hematology

Microbiology

Serology

80. Which of the following is incorrect? * 1 point

>100,000 RBCs/μL indicates blunt trauma injury

Like pleural and pericardial buids, normal peritoneal buid is pale yellow

Lymphocytes account for 64% to 80% of a pleural buid nucleated cell count

Milky pleural buid may be due to the presence of chylous or pseudochylous

material

81. A reagent strip impregnated with 4-methoxybenzene-diazonium- * 1 point

tetrafluoroborate will yield positive reaction with:

Bilirubin

Hemoglobin

Ketones

Urobilinogen
82. All of the following are factors influencing calculi formation, EXCEPT: * 1 point

Optimal urinary pH

Supersaturation of chemical salts in urine

Temperature

Urinary Stasis

83. Organisms that do not cause the appearance of fecal leukocytes: I. * 1 point

Staphylococcus aureus II. Shigella III. Vibrio IV. Rotavirus V. Entamoeba coli

I, III, IV, V

I, II, III, V

I, II, IV, V

I, II, III IV, V

84. Differential-interference contrast microscopy * 1 point

Hoffman

Nomarski

Levaditi

Brenn
85. Using polarized light microscopy which of the following is/are * 1 point

birefringent? I. Uric Acid II. Monohydrate calcium oxalate III. Cystine IV.
RBCs

I, II

III, IV

I, II, IV

I only

86. 2,4-Dinitrophenylhydrazine (DNPH) test is a screening test for which * 1 point

condition?

Hartnup Disease

Homocystinuria

MSUD

Tyrosinemia

87. Pleocytosis is a term used to describe what? * 1 point

A pink, orange, or yellow CSF specimen

An increased protein content in the CSF owing in cellular lysis

Inbammation and sloughing of the cells from the choroid plexus

An increased number of cells in the CSF

88. Hypoglycorrachia would not be seen in: * 1 point

Bacterial meningitis

Viral meningitis

Tubercular meningitis

AOTA

89.  As few as how many neutrophils is indicative of an invasive condition? * 1 point

90. Which of the following conditions lead to the formation of transudate? I. * 1 point
Congestive heart failure II. Nephrotic Syndrome III. Membrane Inflammation
IV. Microbial Infection

I, II

III, IV

I, II, IV

II, III, IV
91. What result can be used to confirm for the presence of effusion caused * 1 point

by lymphatic obstruction?

Strongly positive for Sudan III staining

There is a balanced mixture of cells

Absence of cholesterol crystals

Milky appearance without greenish-tinge

92. Fluid for chromosome analysis should be collected at: * 1 point

after the 14th week of gestation

16 weeks gestation

At the third trimester

After 32 weeks of gestation

93. The result that corresponds to a hemorrhagic process in the joints: * 1 point

Neutrophils increased

Good viscosity

Normal glucose level

Cloudy, yellow-green buid

94. All of the following are found in Acetest tablets, EXCEPT: * 1 point

Sodium carbonate

Disodium phosphate

Lactose

Glycine

95. The reaction time needed for ketones: * 1 point

30 seconds

40 seconds

45 seconds

60 seconds

96. The finding of ________ eosinophils in the urine is considered significant. * 1 point

less than 1%

more than 1%

less than 10%

more than 10%

97. Major constituent of renal calculi * 1 point

Uric Acid

Calcium Oxalate

Phosphate

Cystine

98. The normal renal threshold for glucose in adults is approximately: * 1 point

160-180 g/dL

160-180 mg/dL

160-180 g/L

160-180 mg/L

99. Which of the following urine colors is incorrectly paired with its cause? * 1 point

Port wine: Porphyrins

Blue-green: Clorets

Red: Rifampin

Dark yellow: Diabetes insipidus

100. Hemoglobinuria is most likely noted in urine specimens from patients * 1 point

with which of the following?

Crush syndromes

Brown recluse spider bites

Muscular trauma

Renal calculi

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